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Missing A's, B's, O's Highlight Need for Blood Donors

The American Red Cross and other major companies are dropping the letters A, B, and O — symbols of the main blood groups — from their logos to highlight the critical role every blood donor plays in the hopes of encouraging blood donations. (Published Tuesday, June 12, 2018)

The American Red Cross, America’s Blood Centers and similar agencies are not shy about getting the word out for blood donors — their ads are everywhere, and workers are constantly visiting high schools and college campuses to hold blood drives.

But despite their persistence, the number of donors is dwindling.

The number of blood donors for the American Red Cross has dropped by a little more than 1 million since 2009, and the organization — along with others — has issued pleas for people to turn out to give blood. The agency points out that just 3 percent of the United States’ population donates blood.

"Every day thousands of patients across the United States rely on generous blood donors for critical blood transfusions," said Gail McGovern, president and CEO of the Red Cross, in a recent press release, announcing an initiative to encourage people to donate. "However, we have seen a troubling decline in the number of new blood donors. We urge the public to roll up a sleeve and fill the missing types before these lifesaving letters go missing from hospital shelves."

According to America’s Blood Centers, 40,000 pints of blood are needed per day. But while that number may seem high, the demand for blood has actually dropped in recent years. The fall in demand came about thanks to a number of technological and medicinal advancements in recent years that have helped doctors to improve the utilization of blood products in patient care — especially when it comes to transfusions.

Despite a drop in demand, blood collection centers are still desperate for donors, and experts say people shouldn't be fooled: blood donations are still critical to the health industry, and there is still immense need for more donors.

“What interests me about blood donation is that there’s been a lot of changes over the last 10 years that have affected both the supply and the demand,” said Dr. Eric Gehrie, an assistant professor of Pathology at Johns Hopkins School of Medicine.

For instance, studies done in recent years have shown that patients who have been treated with a more conservative transfusion policy versus those who have been treated with a more liberal transfusion policy have done either the same or better with a more conservative policy, Gehrie said.

And because of medical advancements, doctors are also able to better guage nowadays whether a patient needs a transfusion, he added. Rather than transfusing someone, doctors may, for example, give them medication that can help them.

Gehrie pointed to the Hippocratic Oath that doctors live by in his explanation of the ways in which doctors have shifted from blood transfusions to other methods of care.

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"If there's something that we can do less of, like transfusion, that will actually improve people's outcomes or not expose them to a blood donor if they don’t need to be exposed, and we can simplify care by doing it — we're very motivated to do that," he said.

Nevertheless, he said, blood donations are crucial. And even with alternative forms of care driving down the demand for blood, there is still a desperate need for it.

The American Red Cross’ annual reports show that blood donations began to fall after 2009. And according to Chris Hrouda, president of blood services for the American Red Cross, 2009 was when the organization hit a peak number of transfusions, the “most we’ve transfused ever,” he said.

Since then, yearly blood donors have dropped steadily from 3.8 million people in 2009 to 2.7 million people in 2017, which is the most recent data the organization has released.

“Hospitals have invested a lot in technology,” Hrouda said in a recent phone interview. "Everything from robotic surgeries to better IT systems…around patient outcomes for various things in the health care system, including transfusions.”

It’s a welcome advancement by those in the medical field, but it hasn’t come without drawbacks.

Hrouda said it may be hard for people to understand, since demand has decreased, but there is still an absolute need for blood, which means there’s an absolute need for donors.

“We’ve continued to reduce our collections to manage with demand declines,” he said, adding that because of the decreased demand, people have the perception that they don’t need to donate as frequently.

As recently as last summer, the Red Cross issued a plea for blood donors, citing a “critical blood shortage” which was due, in part, to the season — blood donations tend to fall during the summer.

“The decline in summer donations is causing a significant draw-down of our overall blood supply, and we urgently need people to give now to restock hospital shelves and help save lives,” said Shaun Gilmore, president, Red Cross Biomedical Services said in the July 2017 press release. “Every day, patients recovering from accidents or those receiving treatments for cancer or blood disorders rely on lifesaving blood products regardless of the season.”

Every two years, the Department of Health and Human Services conducts a study into blood collection and use in the United States. The most recent report, published in September 2016, shows data from the year 2013 that represents a 4.4 percent decline in the number of blood units transfused as compared to 2011.

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The study also confirms what blood collection agencies have said: both blood collection and use fell.

“The gap between collection and utilization is narrowing,” the study says. “As collections decline further and hospitals decrease transfusions and manage products more efficiently, the decline in surplus inventory may be a concern for disaster preparedness or other unexpected utilization needs.”

This year, the Red Cross is working to target this issue in an effort to avoid running into the same problem.

Earlier this week, the organization launched an initiative called the “Missing Types Campaign,” meant to “ illustrate the need for new blood donors to ensure lifesaving blood is available for patients,” according a press release from the organization.

To promote the campaign, the letters A, B and O — which are the main blood types — will be taken out of corporate logos, brands, social media pages and websites, in an effort to show the vital role of blood donors.

Also on Monday, the New York Blood Center declared a “blood emergency” in the New York area, calling on people to donate.

“We’re calling on everyone to do what they can to spread the word, host a blood drive or simply take an hour out of their day to donate,” said Andrea Cefarelli, Senior Executive Director of Donor Recruitment for New York Blood Center, in a press release.

The push for donors aligns with World Blood Donor Day, celebrated on June 14. Spearheaded by the World Health Organization, it’s a day meant to both honor blood donors for their efforts, and to raise awareness about the necessity of blood donations.

But even as collection agencies make their pleas for donors heard, experts can’t point to a singular reason for the drop in donors; they say it can be attributed to a number of factors.

One possible reason is tighter guidelines on who can donate blood, which adds to the elimination of a number of donors, Hrouda said. One example of this, he said, is testing hemoglobin in donors.

Hemoglobin is a protein that has iron and carries oxygen to tissues in someone’s body, according to the Red Cross. If the levels in those results for males are too low, they’re deferred for six months, while females are deferred for one year.

“We are decreasing eligibility,” he acknowledged.

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Gehrie, who also serves as the medical director of the blood bank at Johns Hopkins, said the safety of the blood supply is another key issue that can affect who donates.

“Part of keeping the blood supply safe is making sure that the only people who go to donate blood are people who feel good and healthy, and choose on their own to donate blood,” he said.

And while donation centers want to encourage as many people as possible to donate, they don’t want people to feel pressured to donate, he said, because the reality is that they need donors who are healthy and meet the standards required to donate.

Dr. Timothy Hilbert, director of NYU Langone’s Blood Bank, also noted the change in criteria as one possible reason, and raised the issue of consistent donors beginning to age out.

“It’s always easier to collect blood from a donor you have established a relationship with,” he said.

Hilbert, who is also an assistant professor of pathology at NYU, added that there seems to be fewer opportunities for people to donate blood, as some donor centers have closed down. Many hospitals, for example, used to house their own blood donor centers, he said, but several have been shuttered.

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“On the whole, people have fewer opportunities to donate than they did years ago,” he said.

Another reason for the drop could be generational, experts speculate. But there’s no way to tell for sure.

“People of a certain generation, in their mind, donating blood was sort of a civic responsibility that they would do…it was viewed as a positive thing to do,” Gehrie said. “Whereas now, I think people are aware that it’s a little more complicated than that.”

Hrouda echoed that sentiment, saying that the “greatest generation” — the World War II generation — has been a very strong donor base for the Red Cross. But there isn’t strong data to tell whether blood donation falling is truly a generational issue or not.

One thing that is for sure, though, is that blood donation centers are working to appeal to younger generations. Both Hilbert and Hrouda pointed to marketing as a key component of driving donors to collection centers.

“All of these collection agencies have tried to create a social media presence,” Hilbert said, adding that they are “aware that the way people relate to their communities has changed and they’re trying to keep up with that.”

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“People will say donor centers aren’t doing enough, but I believe they are,” Gehrie said. “I do think that they are really trying.”

Hrouda acknowledged that the Red Cross is working to keep up with the way younger generations through social media and other creative campaigns.

“There is still a constant need for blood and I wouldn’t want anybody to walk away from this story thinking they don’t need to donate blood anymore,” Gehrie added. “Because we need it.”